My mother was killed by neglect at ERI

14:21Tuesday 26 April 2005

A FORMER Lord Provost has claimed his mother was killed by "basic neglect" at Edinburgh Royal Infirmary and launched a blistering attack on the standards of care for the elderly at the flagship hospital.

Norman Irons said the care his 89-year-old mother received on the hospital’s orthopaedic ward was "a disgrace in a developed Western country".

The Capital’s former civic leader said he would have made a complaint to the procurator fiscal against the hospital of "institutional neglect" if the law had allowed it.

Mr Irons, who works part-time in the city as the Danish consul, said he believed health chiefs should resign over the issue.

In a scathing letter written to Brian Cavanagh, chairman of NHS Lothian, and Health Minister Andy Kerr, Mr Irons alleges:

 Basic nursing neglect left his mother to develop bedsores and mouth and throat infections.

 Her nutrition and fluids intake were not properly monitored and as a consequence her weight dropped dramatically.

 She received no bath and only two showers in 28 days.

 She was not taken to the toilet quickly enough and her nightclothes were left soiled in her locker for relatives to collect.

 Clinical waste was left lying at her bedside.

 Her self-esteem and her general welfare were neglected to the point where she effectively lost the will to live.

Speaking to the Evening News, a tearful Mr Irons described his mother, Anne Irons, as a slight woman who was very independent and took great pride in her appearance. The pensioner was admitted to hospital after a fall at her Craigleith home in which she fractured her pelvis.

Mr Irons said that his mother’s treatment in the short time she was at the Accident and Emergency unit, and in the Astley Ainslie Hospital where she died, was "exemplary".

It was the 28 days she spent in ward 1.08 at the ERI that Mr Irons said led to his mother’s death from bronchopneumonia on April 9.

She died two days after she was admitted to the Astley Ainslie

Hospital. He said: "In short, the ERI received a patient in good order except for a fracture which needed time to heal. Her only fault apparently was that she was too old to be a matter of concern.

"When she died, her upper arms were thinner than a broom pole - although a broom pole would not have the bed sores."

The prominent nationalist said that his complaint had not been motivated in any way by party political concerns.

A former member of the Health Appointments Advisory Committee, Mr Irons called for greater resources to be handed to nurses on the orthopaedic ward and for either the chairman or the chief executive of NHS Lothian to resign.

"Somebody must be responsible for it," he said. "That’s an institution that’s there to keep people alive, not to kill them.

"I would look to the chief executive and chairman of Lothian Health to take action as a matter of urgency to improve the resources and to ensure that elderly patients are properly nursed and fed in their hospital.

"If that means going back to the Scottish Executive to ask about resources, they should be doing that.

"If she had ended up in that condition in a private nursing home, politicians would be kicking up a riot about conditions. They would have been demanding the closure of it. It’s supposed to be a flagship general hospital."

David Bolton, chief executive of Lothian Universities Hospital Division, said he had received Mr Irons’ complaint.

He said: "I was sorry to hear about Mr Irons’ sad loss. We will fully investigate his concerns, which we were formally notified about on Friday. Once that investigation is completed, NHS Lothian will discuss the findings directly with the family."

An Executive spokeswoman said: "Writing to the Health Board is the correct course of action as matters such as these are best addressed at local level.

"The Health Minister has received a letter today from Shona Robison MSP on behalf of Mr Irons and he will respond to this in due course."

SNP health spokeswoman Shona Robison said Mrs Irons’ case was "heart breaking" and called for an inquiry into discrimination of the elderly in the health service.

She said: "I think this is a wake-up call for us to look to how vulnerable elderly people are treated within the health service.

"I’m not sure that busy acute beds in hospitals are the best place for vulnerable people when they can’t get the personal care and nutrition needs that they need to maintain their dignity."

Tory health spokeswoman Dr Nanette Milne said a complete overhaul of the health service was needed to ensure resources were effectively dished out.

"In general terms, I suspect there’s a lot of hospitals where the nursing staff are under significant pressure to look after patients adequately," she said.

"I suspect it comes down to fighting to meet Government targets and waiting-list targets and I’m not convinced that resources are necessarily going where they ought to be going.

"I think the whole health service has to be looked at and reformed to ensure money goes to the right places at the right time to give the care that’s needed.

"Without reform, money doesn’t achieve the end results."

'IN REALITY SHE DIED OF NEGLECT IN YOUR CARE'

Ex-Lord Provost launches a stinging attack on ERI workers and blames their ‘failures’ for his mother’s death Extracts from the letter sent by Mr Irons to Lothian NHS Board chair Brian Cavanagh and Health Minister Andy Kerr

IT is with a mixture of regret, frustration and anger that I am writing to you about the disgraceful circumstances which preceded my mother’s death in the Royal Infirmary of Edinburgh.

My mother’s [life] was extinguished by basic neglect within an orthopaedic ward where she was accommodated from March 9 to April 5.

Her basic nursing was neglected, her nutrition was neglected, her self-esteem and general welfare were neglected to the point where it was impossible to recover her life. I should say here that her treatment in that ward contrasted with the excellent treatment within other parts of the ERI and Lothian Health NHS. The care and attention in the A&E was exemplary. Her short period in the Astley Ainslie Hospital was characterised by care and carefulness as were her few hours in the Combined Assessment Unit of the ERI. Her care (and the care of our family) during her final day in Ward 2.07 at the ERI could not be faulted.

The intervening period was a disgrace in a developed country. I am aware there is no crime of corporate culpable homicide. I wish, however, I could complain to the procurator fiscal of institutional neglect. The rationale for the neglect appears to be summed up in the proposition "Oh well she was 90 and she was going to die anyway." (Frankly, I think that you or your chief executive should resign although I know that is not fashionable under New Labour.)

My mother was admitted to the A&E department of the ERI on March 9 following a fall at home on March 8. It was established she had a fractured pelvis. All that was required was "recuperation" until the bones knitted, with associated physiotherapy. I anticipated she would be discharged in a few weeks.

In short, the ERI received a good patient in good order except for a fracture which needed time to heal.

Her only fault apparently was that she was too old to be a matter of concern and, of course, she was not part of any waiting list. Quite the opposite. She was a bed blocker and her death cleared a space.

Mrs Irons was visited every day by members of my family. The following points are a distillation of their accounts or experiences.

Personal and hospital hygiene

After her day in A&E we visited in the evening when she had been in the ward for at least two hours. She had not been washed from breakfast time the day before.

During 28 days in Ward 1.08 she was "never given a bath".

She had an assisted shower twice. Her personal hygiene was pretty well left to herself. Part of the problem (not perceived or acknowledged by the ward staff) was that most of the nurses were male. My mother had an aversion (which I believe to be not unreasonable) to being washed all over by a man. (It was unfortunate for her that she was not some 30-year-old with chlamydia. Then she could have gone to a "Well Woman" Clinic where her modesty would have been respected.

But she was ninety and in the ERI. It did not seem to occur to the male staff to do something about this and she got upset if I made a fuss.) It seems to me little wonder that with such little attention to the cleanliness of their elderly patients infections were acquired.

Early on she was sick at night. The staff put her nightdress into a plastic bag for my wife to wash. This foul mess was left in the locker until removed by the relatives.

My mother was seldom taken to the toilet when she needed. The result was more often than not her pants were fouled. Again, no attempt was made within the ward to sluice these or wash off with some disinfectant. They were dumped in a bag (often an open bag) in her locker. How do you think infection is contained in such circumstances?

My mother resorted to requesting a grey paper mache sickness bowl which sat on her bed trolley which was used as a receptacle for antiseptic wipes which we had taken in. I was disgusted to note that on one occasion, after blood had been taken, the clinical waste (the tissues with the blood on it) was also placed in this bowl. On another occasion my wife noted the blood-fouled cotton wool was left on the bed.

Nutrition

She ate little to begin with and as the thrush in her throat (described below) developed, she was unable to swallow properly.

Within a week she was losing weight and her morale was dropping. I intervened and some attention was given to her nutrition. But no-one checked what was consumed or how much. When she died her upper arms were thinner than a broompole. Although a broompole would not have the bed sores.

Nursing

The lack of nursing was probably the worst aspect. It is difficult to believe that she would not be cared for to modern standards.

I understand there is a basic shortage of nurses. There also appears to be a basic lack of nursing and clinical skills. Within three days I expressed concern to the nurse in charge. We were simply treated as interfering relatives.

The next day my daughter-in-law noted my mother’s slurred speech and "furry tongue". It was evident [my mother] had thrush in her mouth and had developed sores on her elbows.

Because of our intervention she was examined by a physician but none of the clinical staff appeared to understand the problem with her mouth.

Two days later no effective action had been taken to deal with the thrush, which had extended into her throat and made her "swallow" almost impossible.

Again my wife asked for a doctor, who did recognise the condition and prescribed medicine. My mother’s condition was, of course, being worsened by her difficulty with eating or drinking.

About March 15 we had a call to say my mother had fallen before "going to the toilet". No-one ever explained in what circumstances an old woman with a fractured pelvis would be out of bed.

She did remark often how busy the nursing staff were. Again it was an embarrassment to her to say that sometimes they were so busy they did not attend the nurse call system or it took so long she and the bed were fouled. It is little wonder she developed sores on her bottom and in her groin.

Modesty prevented her from mentioning these problems until it was too late. But what were the nursing staff doing about this? By the 24th my daughter reported [my mother] had a chest infection and was being X-rayed.

It was suggested she also had a urinary infection but I do not know the truth of this. It would hardly be surprising given no effort was made to check her fluid intake. She appeared to be prescribed a daily dose of laxative but this was unnecessary as it appeared she ended up with diarrhoea.

Self esteem and personal dignity

I asked several times for the staff to arrange for her to have her hair washed and permed. I spoke specifically to the nurse in charge and I left 20. The 20 came back three weeks later , with her possessions. It appears either that it was too much trouble or your staff had too little time. She was dispirited by her appearance as much as by any other circumstance.

I had taken in a couple of pencils and a pen so that she might work on the newspaper crosswords. Again I had to plead with the senior nursing staff to ensure that she received a newspaper in the morning. She received one copy of the Sunday Post on one day during her entire period there. Nursing? She would have received better attention in prison. She was embarrassed that her soiled underwear had to be dealt with by my wife. It is just terrible that you do not have the resources to ensure patients can be taken to a toilet or otherwise dealt with in some dignity.

Consistent with the view that she was an expendable 90-year-old she was treated, effectively, as though she was senile. So her drinks were given to her in a plastic beaker. Only on one reported occasion was she given her tea in a cup, but with no saucer.

Her head went down, along with her weight and then her health, as the weeks went by.

By the time the staff in the Astley Ainslie had her in their care it was too late.

She died on April 9, her cause of death bronchopneumonia. In reality, she died of neglect in your care.

Will you and Mr Barber get into the ERI on Monday and ensure this never happens again?

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